Curative therapy benefits older men with localized prostate cancer

Many older men with localized prostate cancer gain life expectancy and quality-adjusted life expectancy with potentially curative therapy, according to a report in the September 1st Journal of Clinical Oncology.

Men younger than 60 years who have clinically localized prostate cancer are 25 times more likely than men age 70 years or older to receive radical prostatectomy (RP), the authors explain, perhaps because of a perception that older men are unlikely to benefit from such potentially curative therapy. Dr. Shabbir M.H. Alibhai from University Health Network, Toronto, Ontario, Canada and colleagues evaluated three treatments – RP, external beam radiotherapy (EBRT), and watchful waiting – using a decision-analytic Markov model of data from 141 prostate cancer patients and from published studies. For most men over age 65 with grade 1 (Gleason score 2 to 4) disease, watchful waiting resulted in superior quality-adjusted life expectancy (QALED) compared with RP and EBRT, given the adverse quality-of-life effects associated with treatment complications. The choice of treatment for grade 2 (Gleason score 5 to 7) disease, however, depends on the data employed by the model. Cohort data favor RP for men up to age 75 years, after which watchful waiting has the highest QALE. Case-series data, on the other hand, favor watchful waiting for men 65 years and older. For otherwise healthy men with grade 3 (Gleason score 8 to 10) disease, the researchers note, either RP or EBRT brings improved life expectancy and QALE compared with watchful waiting up to age 85 years, regardless of the source data used by the model.Overall, benefits of potentially curative therapy were restricted to men with no worse than mild comorbidity.”Decision-making in prostate cancer is clearly complex, given the lack of randomized trial data,” Dr. Alibhai told Reuters Health. “Patients must be evaluated in the context of their age, comorbid conditions, Gleason score, and preference with respect to extending life versus preserving urinary and sexual function.” “Based on all of the data accumulating,” he continued, “I believe there is a survival advantage to treating patients with either surgery or radiotherapy, although the gains may be huge or more modest, particularly for Gleason 5-6, given the uncertainty of the data.” “Many men aged 70 to 80 who are generally well or have well-controlled, stable diseases such as diabetes, asthma, or hypertension, will benefit from aggressive therapy for high-grade disease,” Dr. Alibhai concluded. “I believe we need to be more aggressive in treating this group of patients.” (Source: J Clin Oncol 2003;21:3318-3327: Reuters Health: Will Boggs, MD: September 18, 2003: Oncolink)